Some perils in therapeutic bed rest during pregnancy, studies say

PITTSBURGH — When Michelle Massucci went into preterm labor with twins almost four months before her due date, she followed her doctor’s orders for strict bed rest.

For six weeks in the hospital, she was allowed out of bed only to shower and go to the bathroom, and some days not even to do that. For another four weeks at home, she laid on her living room couch day and night, needing family help even to get herself a sandwich.

“It’s funny — people say to me, ‘I wouldn’t have been able to do it,’” she said.

“To be completely honest with you, you wouldn’t think of doing anything other than that because the health of your babies is in your hands.”

To this date, Massucci of Ross, Pa., credits bed rest with helping to keep her pregnant as long as she was — delivering twins Justin and Madelyn at 35 weeks gestation (for twins 37 weeks is considered full-term delivery).

And for many years, that was indeed the prevailing wisdom.

But now — just seven years after Massucci’s twins were born — strict bed rest is becoming a thing of the past.

An editorial that ran last summer in the journal Obstetrics and Gynecology used the phrase “unethical and unsupported” about therapeutic bed rest.

“Not all interventions that make some sense are scientifically valid, and this is one of them,” said Dr. Ronald Thomas, division director for maternal-fetal medicine at the West Penn Allegheny Health System.

Thomas said bed rest has been a tempting solution to all manner of problems in pregnancy because it seems logical that sharply reduced activity would put less stress on the body, making an early birth less likely to occur.

“People have used it for all sorts of things — history of preterm birth, contractions in the current pregnancy, multiple gestation,” he said. “You name it, someone has suggested it as a possibility.”

But what recent studies have found is that not only is there no evidence that bed rest helps any of those conditions, but that strict bed rest can do both physical and economic harm, said Dr. Hyagriv Simhan, chief of maternal fetal medicine at Magee-Womens Hospital of the University of Pittsburgh Medical Center.

The risk of blood clots increases, he said, and women can quickly have atrophied muscles and bone demineralization that can increase the risk of osteoporosis, the brittle-bone disease. In addition, women who are prevented from working can experience economic stress.

Indeed, when Massucci came home from her six weeks on hospitalized bed rest, her muscles had atrophied to the point where she struggled just to lift her leg to step up onto the curb outside her house. “To be honest, I was in pretty bad physical condition,” she said. “I definitely was in a state where my muscle tone was long gone.”

Thomas cautioned that there is a difference between strict bed rest and modifying strenuous activity. It is advisable for pregnant women to take it easy, he said, meaning that strenuous activities can and should be reduced during pregnancy.